24-hour Fax: 541-757-2894
To print this form, go to: "FILE," and select "PRINT".
Fill out the form and FAX it in, OR --    Click here to print

PLEASE INCLUDE ALL OF THE FOLLOWING:

Today's Date __________________________________________________________

Date For Delivery _______________________________________________________

Sender's Name _________________________________________________________

Sender's Address with zip________________________________________________

(City, State, Zip)_______________________________________________________

Sender's Phone & FAX Numbers ___________________________________________

Sender's E-Mail Address__________________________________________________

Sender's Credit Card ##________________________________Expiration:_________ 

Recipient's Name _______________________________________________________

Company Name (if applicable)_____________________________________________

Recipient's Address _____________________________________________________

Recipient's Phone Number ________________________________________________

Any Instructions?_______________________________________________________

What Do You Wish to Send?______________________________________________ 

Second Choice__________________________________________________________

Price level (delivery charges will be added, no sales tax in Oregon)______________

Message for the Card: ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
Thank you for you order. We will call or FAX, or email you back to confirm.
When finished CLICK HERE to return to the order page

InBloom.com
1324 SW Ninth St.
Corvallis, OR 97330
541-752-5666 or 1-800-405-5666
Fax 541-757-2894
Hours Mon - Fri 9AM - 6PM, Sat 10AM-4PM, Sunday closed, phones answered 24/7